Images in Clinical Medicine
Pneumoperitoneum Due to Spontaneously Perforated Pyometra
N Engl J Med 2006; 354:e23May 25, 2006
- Article
A 40-year-old woman with long-standing diabetes presented to the emergency room with fever (temperature, 39.5°C) and diffuse abdominal pain. On admission, she had a distended abdomen with muscular rigidity, Blumberg's sign, a white-cell count of 23,530 per cubic millimeter, and a C-reactive protein level of 27.5 mg per deciliter. A chest roentgenogram, obtained while the patient was erect, showed bilateral subphrenic free air (Panel A, arrowheads). Computed tomography showed a large abscess (11 cm) containing air (Panel B, arrowhead) in the lower abdomen. At laparotomy, a perforated necrotic area on the uterine fundus (Panel C, arrowhead) and infected ascites were noted. The patient was treated with subtotal hysterectomy and drainage and had an uneventful recovery.
Ming-Shian Tsai, M.D.
Ming-Hsun Wu, M.D.
National Taiwan University Hospital, Taipei 100, Taiwan- Citing Articles (2)
Citing Articles
1
Pi-Hua Chen, Hsien-Liu, Su-Long Lee, Chih-Yang Chang, Chi-Chang Chang. (2011) Pneumoperitoneum caused by perforation of pyometra associated with a lost intrauterine device and perforated malignancy of the sigmoid colon. Taiwanese Journal of Obstetrics and Gynecology 50:1, 124-125
CrossRef2
Yu-Che Ou, Kuo-Chung Lan, Hao Lin, Ching-Chou Tsai, Chan-Chao ChangChien. (2010) Clinical characteristics of perforated pyometra and impending perforation: Specific issues in gynecological emergency. Journal of Obstetrics and Gynaecology Research 36:3, 661-666
CrossRef
